Chapter 44

A client is being discharged after applications of a plaster leg cast. The nurse determines that the client understands proper care of the cast if the client makes which statement?

"I need to avoid getting the cast wet."

A nurse is reinforcing dietary teaching about calcium-rich foods w/ a client who. has osteoporosis. Which of the following foods should the nurse include in the instructions?

Broccoli

A nurse is reviewing the health record of a client who is to undergo total joint arthroplasty. The nurse should recognize which of the following findings as a contraindication to this procedure?

Bronchitis 2 weeks ago

The nurse is caring for the client who has had skeletal traction applied to the left leg. The client is complaining of severe left leg pain. Which action would the nurse take first?

Check the client's alignment in bed

A nurse is assisting w/ the care of a client following a veterbroplasty of the thoracic spine. Which of the following actions should the nurse take?

Ensure client maintains a supine position

A client w/ acute muscle spasm has been taking baclofen. The client calls the clinic nurse because of continuous feelings of weakness and fatigue and asks the nurse about discontinuing the medication. The nurse would make which appropriate response to the client?

"Weakness and fatigue commonly occur and will diminish w/ continued medication use."

A nurse is reinforcing teaching with a client who is going to have a bone scan. Which of the following statements should the nurse include?

"You will have to urinate just before the procedure."

A nurse is reinforcing preoperative teaching for a client who is to undergo an arthroscopy to repair a shoulder injury. Which of the following statements should the nurse include? Select all that apply

- "inspect your incision daily for indications of infection." - "Apply ice packs to the area for the first 24 hours." - "Perform isometric exercises."

A nurse is assisting w/ performing health screenings at a health fair. Which of the following clients have a risk factor for osteoporosis? Select all that apply

- A 45-y/o client who has been taking phenytoin for 20 years - A 50-y/o client who has smoked tobacco for 5 years

A nurse is reinforcing teaching w/ a client who has osteoarthritis of the hip and knee. Which of the following information should the nurse include? Select all that apply

- Apply heat to joints to alleviate pain - Ice inflamed joints for 30 minutes following activity - Massage can alleviate pain of joints

A nurse is contributing to the plan of care for a client who will undergo an EMG. Which of the following actions should the nurse include? Select all that apply

- Assess for burning - Determine whether the client takes a muscle relaxant. - Instruct the client to flee muscles during needle insertion

The nurse returns to their own car to retrieve clean gloves and towels and asks a few witnesses for help. Pace in order the steps the nurse should take in the management of the traumatic amputation.

- Call 911 - Use clean towels to apply pressure to the site of the amputation. - Ask a witness to don gloves and hold the victim's leg above their heart -Wrap the amputated foot in a clean cloth and place in a zippered bag a witness retrieved from a nearby store.

A nurse working on an orthopedic unit is caring for a client following actions should the nurse take? Select all that apply

- Check continuous passive motion device settings - Request a referral for outpatient physical therapy - Palpate dorsal pedal pulses

A nurse is reinforcing teaching w/ a client who has a Hx of low back injury. Which of the following instructions should the nurse provide the client to prevent future problems w/ low-back pain? Select all that apply

- Engage in regular exercise including walking - Create a smoking cessation plan - Wear low- healed shoes

A nurse is collecting data from a client who has osteoarthritis of the knees and fingers. Which of the following manifestations should the nurse expect to find? Select all that apply

- Herberden's nodes - Enlarged joint size - Limp when walking

The nurse is preparing a list of cast care instructions for a client who just had a plaster cast applied to his right forearm. Which instructions would the nurse include on the list? Select all that apply

- Keep the cast and extremity elevated - The cast needs to be kept clean and dry - Allow the wet cast 24-72 hours to dry

A nurse is contributing to the plan of care for a client who is post-op following an arthroscopy of the knee. Which of the following nursing actions are appropriate? Select all that apply

- Monitor color and temperature of the extremity - Place pillows under the extremity - Monitor pulse and sensation in the foot - administer analgesic medication

A nurse is collecting data from a client who is scheduled to undergo a right knee arthroplasty. The nurse should expect which of the following findings? Select all that apply

- Pain when bearing weight - Swelling of the affected joint - Limited joint motion

A nurse is reinforcing teaching w/ a client who had total hip arthroplasty. Which of the following information should the. Select all that apply

- Perform calf and leg exercises q2h - Remain at a 90 degree angle when sitting - Use a raised toilet seat

A nurse is providing post-op care for a client who has a total hip arthroplasty. Which of the following actions should the nurse take? Select all that apply

- Provide a raised toilet seat for the client . - Use an abductor pillow when turning the client - Instruct the client on the use of an incentive spirometer

Which suggestions for the plan of care should the nurse make for this client? Select all the apply.

- Record amount, color, and odor of wound drainage - Compare pulses in the affected extremity w/ pulses in the other extremity - Discontinue elevation of the extremity after 24 hours

A nurse is reviewing the EHR of a client sho has suspected osteoporosis. Which of the following findings should the nurse identify as a a risk factor for osteoporosis? Select all that apply

- Remove throw rugs in walkways - Use prescribed assistive devices. - Remove clutter from the environment - Maintain lightning of doorway areas

During the monitoring of a client's response to disease-modifying anti rheumatic drugs, which findings would the nurse interpret as acceptable responses? Select all that apply.

- Symptom control during periods of emotional stress - Normal WBC, platelet abd neutrophil counts - Radiological findings that show non-progression of joint degeneration - An increased ROM in the affected joints 3 months into therapy

A nurse is reinforcing teaching w/ clients at a health fair about dual-energy x-ray absorptionmetry scans. Which of the following information a should the nurse include? Select all that apply

- The hip and spine are the usual areas the device scans - Bone pain can indicate a need for a scan - Females should have a baseline during 40-49 years

The nurse is planning to reinforce instructions to the client about how to stand on crutches. In the instructions the nurse would plan to tell the client to place the crutches in which position?

8 inches to the front and side of the client's toes

The nurse is reviewing the record of a client who has been prescribed baclofen. Which disorder would alert the nurse to to contact the HCP?

A seizure disorder

Dantrolene sodium is prescribed for a client experiencing flexor spasms, and the client asks the nurse about the action of the medication. The nurse responds knowing that which is the therapeutic action of this medication?

Acts directly on the skeletal muscle to relieve spasticity

The nurse is reinforcing discharge instruction to a client receiving baclofen. Which would the nurse include in the instructions?

Avoid the use of alcohol

The nurse is monitoring a client receiving baclofen for which side effects r/t this medication. Which would indicate that the client is experiencing a side effect?

Drowsiness

The nurse is assigned to care for a client w/ multiple traumas who is admitted to the hospital. The client has a leg fracture, and a plaster cast has been applied. In positioning the casted leg, the nurse would perform which intervention?

Elevate the leg on pillows continuously for 24- 48 hours

The nurse is caring for a client w/ a fresh application of a plaster leg cast. The nurse would plan to prevent the development of compartment syndrome by which action?

Elevating the limb and applying ice to the affected leg

Cyclobenzaprine is prescribed for a client to treat muscle spasms, and the nurse is reviewing the client's record. Which disorder would indicate a need to contact the HCP regarding the administration of this medication?

Glaucoma

A nurse is assisting w/ teaching a class about types of fractures. Match the type of fracture w/ the associated characteristics.

Greenstick- Fracture occurs on one side of the bone but does not extend completely through the bone Impacted- Fractured bone is wedged inside another bone fragment. Spinal- Fracture that winds around the bone. Oblique- Fracture occurs at an angle and across bone Impacted bone-Bone is fragmented

The nurse witnesses a client sustain a fall and suspects that the client's leg may be fractured. Which action is the priority?

Immobilize the leg before moving the client

A client has sustained a closed fracture and has just had a cast applied to the affected arm. The client is complaining of intense pain. The nurse has elevated the limb, applied an ice bag and administered an analgesic, which was ineffective in relieving the pain. The nurse interprets that this pain may be caused by which condition?

Impaired tissue perfusion

The nurse is reviewing the laboratory studies on a client receiving dantrolene sodiums. Which laboratory test (s) would identify an adverse effect associated w/ the administration of this medication?

Liver function tests

The nurse is evaluating the client's use of a cane for left-sided weakness. The nurse would intervene and correct the client if the nurse observed that the client performed which action?

Moves the cane when the right leg is moved

The nurse has provided instructions regarding specific leg exercises for the client immobilized in right skeletal lower leg traction. The nurse determines that the client needs further teaching if the nurse observes the client doing which activity?

Performing active ROM to the right ankle and knee.

A client is complaining of skin irritation from the edges of a cast applied the previous day. The nurse would plan for which intervention?

Petaling the cast edges w/ adhesive tape

The nurse is checking the casted extremity of a client. The nurse needs to check for which sign indicative of infection?

Presence of a "hot spot" on the cast

A client with a hip fracture asks the nurse why buck's ext. traction is being applied before surgery. The nurse's response is based on the understanding that the Buck's ext. traction has which primary function?

Provides comfort by reducing muscle spasms and provides fracture immobilization

A nurse is reinforcing teaching about capsaicin cream w/ a client who reports continuous knee pain from osteoarthritis. Which of the following information should the nurse include?

Put on gloves before applying the cream to other parts of the body.

A nurse is caring for a client who injured their lower back due to a fall and reports sharp pain in their back and down their left leg. In which of the following positions should the nurse place the client to attempt to decrease their pain?

Semi-fowler's w/ a pillow under the knees

The nurse is evaluating the pin sites a client in skeletal traction. The nurse would be least concerned w/ which findings?

Serous drainage

A nurse is assisting w/ teaching a class about types of tractions. Sort the following characteristics into those associated w/ skin traction and those associated w/ skeletal traction.

Skin Traction - Weights are attached to a boot - Uses 5-10lb weights Skeletal Traction - Screws are inserted into bone - Uses 15-30lbs weights

The nurse is one of several people witness a vehicle hit a pedestrian at a fairly low speed on a small street. The individual is dazed and tries to get up and the leg appears fractured. The nurse would plan to perform which action?

Stay with the person and encourage the person to remain still.

Alendronate is prescribed for a client w/ osteoporosis and the nurse is providing instructions for the administration of the medication. Which of instruction would the nurse reinforce?

Take the medication w/ a full glass of water after rising in the morning

The client has been taking medications for rheumatoid arthritis for 3 weeks. During administration of etanercept, it is most important for the nurse to collect which data?

The WBC and platelet counts